Canadian Medical Assoc's new guidelines4 bc screening--you are not going 2like this

[Lani]

Maybe cost effective not to screen, may avoid some biopsies, but doubt it will SAVE any lives (versus screening)


New breast cancer screening guidelines released

Canadian Task Force on Preventive Health Care issues updated guidelines

New breast cancer screening guidelines for women at average risk of breast cancer, published in CMAJ (Canadian Medical Association Journal) (pre-embargo link only) http://www.cmaj.ca/site/embargo/cmaj110334.pdf, recommend no routine mammography screening for women aged 40-49 and extend the screening interval from every 2 years, which is current clinical practice, to every 2 to 3 years for women aged 50-74. The guidelines also recommend against routine clinical breast exam and breast self-examination in asymptomatic women.

The guidelines, aimed at physicians and policy-makers, provide recommendations for mammography, magnetic resonance imaging (MRI), breast self-exams and clinical breast exams by clinicians. They target average-risk women in three age groups (40󈞝, 50󈞱 and 70󈞶 years) who have not had breast cancer and do not have a family history of breast cancer in a mother, sister or daughter.

"As the Guideline on Breast Cancer Screening was last updated in 2001 and breast cancer screening has since become a subject for discussion amongst doctors and patients, the revitalized Canadian Task Force selected breast cancer screening as the topic for its first guideline," said Dr. Marcello Tonelli, Chair of the Task Force on Preventive Health Care and Associate Professor at the University of Alberta, Department of Medicine, in Edmonton, Alberta. "We intend that this Guideline, which reflects the latest scientific evidence in breast cancer screening, be used to guide physicians and their patients regarding the optimum use of mammograms and breast examination."

According to the guideline, outcomes of breast cancer screening such as tumour detection and mortality must be put into context of the harms and costs of false–positive tests, overdiagnosis and overtreatment. False–positive results can have a significant impact on the emotional well-being of patients and families. They can cause lifestyle disruptions and result in costs to both patients and the health care system.

"Providing Canadians with guidelines that reflect the most current scientific evidence is our priority," said Dr. Tonelli. "We encourage every woman to discuss the risks and benefits of screening with their doctor before deciding on the best approach for them."

Key recommendations:

No routine mammography for women aged 40-49 because the risk of cancer is low in this group while the risk of false–positive results and overdiagnosis and overtreatment is higher

Routine screening with mammography every two to three years for women aged 50-69

Routine screening with mammography every two to three years for women aged 70-74

No screening of average-risk women using MRI

No routine clinical breast exams or breast self-exam to screen for breast cancer.

"There was no evidence that screening with mammography reduces the risk of all-cause mortality," state the authors. "Although screening might permit surgery for breast cancer at an earlier stage than diagnosis of clinically evident cancer (thus permitting the use of less invasive procedures for some women), available trial data suggest that the overall risk of mastectomy is significantly increased among recipients of screening compared with women who have not undergone screening."

In addition to the full guidelines, one-page information pieces are available for both physicians and patients on the task force website: www.canadiantaskforce.ca

The Canadian Task Force on Preventive Health Care is an independent body of 14 primary care and prevention experts. The task force has been established by the Public Health Agency of Canada to develop clinical practice guidelines that support primary care providers in delivering preventive health care.

In a related commentary http://www.cmaj.ca/site/embargo/cmaj111721.pdf, Dr. Peter Gøtzsche, Nordic Cochrane Centre, Copenhagen, Denmark, writes, "these guidelines are more balanced and more in accordance with the evidence than any previous recommendations."

He states that evidence does not support mammography screening and argues that screening is ineffective and even harmful because diagnosis of cancers that would otherwise be undetected lead to life-shortening treatments and mastectomies.

"The main effect of screening is to produce patients with breast cancer from among healthy women who would have remained free of breast disease for the rest of their lives had they not undergone screening," writes Dr. Gøtzsche.

"The best method we have to reduce the risk of breast cancer is to stop the screening program," he concludes. "This could reduce the risk by one-third in the screened age group, as the level of overdiagnosis in countries with organized screening programs is about 50%."

[Lani]

Canadian BC Screening Guidelines Cost Lives

Canadian Task Force on Preventive Health Guidelines for Breast Cancer Screening Ignore Best Evidence and Would Cost Thousands of Lives Each Year

New breast cancer screening guidelines by the Canadian Task Force on Preventive Health (CTFOPH), which recommend against annual screening of women ages 40-49 and extending time between screens for older women, ignore results of landmark randomized control trials which show that regular screening significantly reduces breast cancer deaths in these women. While implementation of the CTFOPH guidelines may save money each year on screening costs, the result will be thousands of unnecessary breast cancer deaths.


Hellquist et al and Tabar et al, respectively, the largest and perhaps longest breast cancer screening trials ever performed, proved regular mammograms reduced breast cancer deaths by approximately a third – even in women 40-49. Their exclusion from CTFOPH consideration raises serious concerns about the CTFOPH analysis.


The Canadian guidelines, published in the Canadian Medical Association Journal, largely mirror those released by the United States Preventative Services Task Force (USPSTF) in 2009. The USPSTF approach misses 75 percent of cancers in women 40-49 and up to a third of cancers in women 50-74. An analysis (Hendrick and Helvie) in the American Journal of Roentgenology, showed that, if USPSTF recommendations were followed, 6,500 additional women each year in the U.S. would die from breast cancer. A similar proportion of Canadian women will likely die unnecessarily each year from breast cancer if the CTFOPH guidelines are followed.


“Panels without profound expertise in breast cancer screening should not be issuing guidelines. These recommendations are derived from flawed analyses and they defy common sense. Women and providers who are looking for guidance are getting bad advice from both Task Forces,” said Barbara Monsees, MD, chair of the American College of Radiology Breast Imaging Commission.


According to National Cancer Institute data, since mammography screening became widespread in the early 1990’s, the U.S. breast cancer death rate, unchanged for the previous 50 years, has dropped well over 30 percent. Every major medical organization with expertise in breast cancer care, including the American Congress of Obstetricians and Gynecologists (ACOG), American Cancer Society, American College of Radiology, and Society of Breast Imaging continue to recommend that women begin receiving annual mammograms at age 40.


“The Canadian guidelines may significantly impact the ability of women to get a mammogram in their community. The result may be to reverse the tremendous gains made against breast cancer over the last two decades,” said Dr. Monsees.

[Laurel]

The Nuks are nuts.

[chrisy]

You're right - don't like that, but do like the denouncing news post where the ACR (something something of radiologists) call bull.

[PinkGirl]

I don't see what has changed. Canadian women have always started
mammograms at age 50 and have ct's, mri's and mammograms at any age if they are high risk or having problems.

[caya]

Pink is correct. Any Canadian woman can go to her GP and request a mammogram. I started at age 40 and continued every year, including the year I was diagnosed by sheer luck while undergoing a breast reduction. The mammo missed my tumour because of my dense breasts.

all the best
caya
(in Florida on vacation)

[Lani]

Routine screening with mammography every two to three years for women aged 50-69

Routine screening with mammography every two to three years for women aged 70-74

Every two or three years does not sound likely yearly to me!

[PinkGirl]

"Providing Canadians with guidelines that reflect the most current scientific evidence is our priority," said Dr. Tonelli. "We encourage every woman to discuss the risks and benefits of screening with their doctor before deciding on the best approach for them."

That's pretty much how it works here ... the woman will 'discuss' and then have a mammo every year ...

[caya]

Lani

The every two to three years is only a guideline. Any Canadian woman can ask her doctor for a mammogram every year and get one. I get a yearly pelvic transvaginal ultrasound, a bone density test, pretty well anything I discuss with my doctor, she/he will write me a referral for any test.
And don't forget, ALL Canadian citizens are covered for health care- from a yearly physical to a walk-in clinic visit to an ER visit for a broken leg to emergency brain aneurysm surgery to chemo and Herceptin. No insurance forms to fill out, no worrying about losing coverage if you lose your job. You are covered from the moment you are born.

So I'm willing to put up with some guidelines that perhaps may not be the same as American standards, to have the wonderful EQUAL health care ALL Canadians have. I realize these are two separate issues, but sometimes in life one has to give a little to get a lot.

All the best
caya
(from Florida)

[Lani]

Glad to hear how Canadian doctors feel free not to follow the guidelines.

Unfortunately in the US, insurance companies seem to love to use guidelines as an excuse not to pay and fail to allow individual circumstances or judgement to enter into the matter.

[AlaskaAngel]

That is an interesting point -- the degree to which insurance companies influence medical care in the USA in comparison.

A.A.

[Britbee]

Then I am really glad I live in Canada. Have a wonderful Doctor that has actually saved my life twice through mammos. Always insisted on full physical once a year with pap smears blood tests and mammo. Used to detest it but got to say this last year when they found the cancerous lymph node through mammo and it was HER2 would not have wanted to wait longer to find out about it!

[hutchibk]

In the US, insurance companies (which have terrible guidelines) follow Medicare guidelines first and foremost (which are monsterously terrible as a starting point), unless the insurance companies are bullied into paying something. Medicare is much harder to bully, but the guidelines start with them.

[norkdo]

My surgeon brought up this stupid new guideline to scoff at it and to say how not one of his colleagues has even a grain of respect for anyone on the taskforce that wrote these guidelines. He said "no doctor I know would ever sabotage their patients' health by following these ridiculous guidelines."

One of the members of the task force was interviewed on the radio and she said it had "nothing to do with saving money." The reporters, like the public and the doctors who phoned in, screaming at her, are mystified. Why risk lives? How many women who think they are not high risk have all the facts about whether they are adopted or whether a grandmother had breast cancer ...when women used to deny having breast cancer out of prudery.